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HomeMy WebLinkAboutCardinal Paving Solutions 1-1-18 MARKCAROPC PDEANOVICH ACORO CERTIFICATE OF LIABILITY INSURANCE D01/03/2017ATE ) 01/03/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER N% r CT Pamela Deanovich,CISR Jackson Kahl Insurance Services,LLC PHONE No,Eat):(920)923-40201112 I FAX )218-6850 17 N Pioneer Road ( (NC,No):(866 Fond Du Lac,WI 54935o� �Ss:pdeanovichjjacksonkahl.com INSURER(S)AFFORDING COVERAGE NAIC a INSURER A:Secura Insurance 22543 INSURED Mark Cardinal Concrete Construction Co.,Inc. INSURERB: Cardinal Paving Solutions,LLC INSURERC: Accurate Material Placement,LLC INSURER D: 490 Ledgewood Drive Fond du Lac,WI 54937 INSURERS: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBRINS() VY POLICY NUMBER POLICY EFF POLICY EXP LIMITS LIR INS() IMMIDD/YYYYI IMMIDDIYYYYI A X COMMERCIAL GENERAL UABIUTY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE X OCCUR TC3188179 01/01/2017 01/01/2018 DAGE O EoNcTrDre nce) 100,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE i 2,000,000 X POLICY ja LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: COMBIN $ A AUTOMOBILE UABIUTY Ea accideD SINGLE LIMIT $ 1,000,000 X ANY AUTO A3188180 01/01/2017 01/01/2018 BODILY INJURY(Per person) $ — OWNED TOSS ONLY SCHEDULED SyUyLNEEDp BODILYO INJURYp (Per accident) $ X AUTOS ONLY X AUTOI ONLY ((Perr accident)AMAGE $ _ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE S DED RETENTIONS t A WORKERS X ATUTE X ERH AND EMPLOYERS'LIA ANY PROPRIETOR/PARTNER/EXECUTIVE YIN WC3188181 01/01/2017 01/01/2018 E.L.EACH ACCIDENT S 500,000 OFFICER/MEMBER EXCLUDED? N N I A 500�oOQ (Mandatory n ) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) RECEIVE D� FEB102011 clrr cLEui< C CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cityof Oshkosh c/o CityClerks Office THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. PO BOX 1130 Oshkosh,WI 54903 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD